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At some point in their late 30s or 40s, many women start noticing that their body has… changed.
You’re suddenly:

• waking up at 3 a.m. for absolutely no reason
• sweating like you ran a marathon while sitting still
• forgetting words mid-sentence
• irrationally angry at the sound of someone chewing

And somehow simultaneously exhausted and unable to sleep.
Naturally, most women assume:

• they’re stressed
• they need more coffee
• they’re “just getting older”
• or they’re slowly losing their mind

But often?
It’s perimenopause.
And unfortunately, a lot of women have no idea it’s happening because nobody talks about what this transition actually looks like beyond hot flashes.
So let’s fix that.

What Is Perimenopause?
Perimenopause is the transition phase leading up to menopause, where hormone levels begin fluctuating before eventually declining.
It can begin as early as your mid-30s, though most women notice symptoms in their 40s.
This phase can last anywhere from:

• a few months
• to 10+ years

Which feels slightly rude, honestly.
Menopause itself is technically just one day — when you’ve gone 12 consecutive months without a menstrual cycle.
Perimenopause is the chaotic hormonal rollercoaster leading up to it.

What Your Hormones Are Doing During Perimenopause
This is where things get interesting.
During perimenopause, your hormones don’t decline in a smooth, predictable way.
They fluctuate wildly.
The main players are:
Estrogen
Estrogen starts rising and falling unpredictably.
Low estrogen can contribute to:

• hot flashes
• poor sleep
• vaginal dryness
• brain fog
• mood changes
• joint pain

But interestingly, estrogen can also temporarily spike high during perimenopause, which can contribute to:

• breast tenderness
• heavy periods
• bloating
• migraines

So yes, your hormones are basically freelancing at this point.

Progesterone
Progesterone often declines first because ovulation becomes less consistent.
Lower progesterone is associated with:

• anxiety
• poor sleep
• irritability
• feeling “wired but tired”

Progesterone has a calming effect on the brain, so when it drops, many women feel noticeably more anxious or overstimulated.

Testosterone
Women also produce testosterone — and levels gradually decline with age.
Low testosterone may contribute to:

• low libido
• reduced motivation
• lower energy
• muscle loss
• decreased recovery from exercise

Which explains why workouts suddenly feel harder and your body composition starts changing despite doing the same things you’ve always done.

Common Signs of Perimenopause
These are the symptoms most women have at least heard of:
1. Irregular PeriodsCycles may become:

• shorter
• longer
• heavier
• lighter
• wildly unpredictable

Basically, your uterus starts acting like it no longer respects calendars.

2. Hot Flashes & Night SweatsOne moment you’re fine.
The next moment you’re stripping layers off in the grocery store wondering if spontaneous combustion is possible.
Hot flashes affect up to 80% of women during menopause transition (North American Menopause Society).

3. Sleep ProblemsMany women struggle with:

• falling asleep
• staying asleep
• waking between 2–4 a.m.

Hormonal fluctuations directly impact sleep quality and circadian rhythm regulation.

4. Weight Gain Around the MidsectionDeclining estrogen changes fat distribution patterns, causing more abdominal fat storage.
Add stress, muscle loss, and poor sleep into the mix and suddenly your jeans become emotionally triggering.

5. Mood ChangesIncreased anxiety, irritability, overwhelm, and even depression can occur during perimenopause.
Research shows women are at higher risk for mood disturbances during hormonal transition periods (Soares, Journal of Psychiatry & Neuroscience, 2014).

Less Common (But Very Real) Signs of Perimenopause
This is the stuff nobody warns women about.
1. Heart Palpitations
Many women experience fluttering or racing heart sensations due to hormonal fluctuations.
Very unsettling. Very common.

2. Joint Pain
Estrogen has anti-inflammatory properties. Lower levels can contribute to:

• aching joints
• stiffness
• increased soreness

Many women suddenly feel like they aged 40 years overnight after sitting cross-legged for too long.

3. Brain Fog
Difficulty focusing, forgetfulness, and trouble finding words are extremely common.
You’re not losing intelligence. Your hormones are affecting neurotransmitter activity.

4. Increased Sensitivity to Stress
Things that used to roll off your back suddenly feel overwhelming.
That’s partly because estrogen and progesterone help regulate the nervous system and cortisol response.

5. Changes in Skin and Hair
Lower estrogen impacts collagen production, hydration, and hair growth cycles.
Which explains why your skin suddenly feels dry while random chin hairs somehow thrive.
Nature is fascinating.

What Women Can Do to Help Their Symptoms
The good news?
You are not powerless here.
Lifestyle changes can significantly improve symptom management.

1. Strength Training
This is one of the best things women can do during perimenopause.
Strength training helps:

• preserve muscle mass
• improve insulin sensitivity
• support metabolism
• improve bone density
• reduce stress

Research consistently shows resistance training improves body composition and quality of life in midlife women.

2. Prioritize Protein
Women in midlife need more protein than most realize to support:

• muscle maintenance
• recovery
• metabolism
• satiety

Aim for roughly:

• 25–35g protein per meal

3. Improve Sleep Hygiene
Helpful strategies include:

• reducing alcohol
• limiting screens before bed
• consistent sleep schedules
• managing stress
• magnesium supplementation (when appropriate)

4. Reduce Chronic Stress
High cortisol worsens:

• belly fat
• sleep problems
• mood symptoms
• inflammation

Walking, strength training, sunlight exposure, therapy, and recovery all matter here.

5. Explore Hormone Replacement Therapy (HRT)
For many women, HRT can be life-changing.
According to the North American Menopause Society, hormone therapy is the most effective treatment for:

• hot flashes
• night sweats
• vaginal dryness

And it may also help:

• sleep
• mood
• bone health
• quality of life

Common HRT options include:

• estrogen patches
• oral estrogen
• progesterone capsules
• estrogen creams or gels
• vaginal estrogen
• testosterone therapy (in some cases)

There are both:

• FDA-approved bioidentical options
• compounded hormone therapies

The best choice depends on:

• symptoms
• health history
• risk factors
• personal preference

This is why working with a knowledgeable provider matters.

Final Thoughts
Perimenopause is not “just aging.”
It’s a major hormonal transition that affects:

• metabolism
• mood
• sleep
• body composition
• brain function
• energy levels

And women deserve better information and support during this phase.
If you’ve been feeling unlike yourself lately, there’s a good chance your hormones are involved.
And no — you are not crazy.
Your hormones are simply rewriting the operating manual without notifying anyone first.

Sources

• North American Menopause Society
• Soares CN. Journal of Psychiatry & Neuroscience, 2014
• Santoro N et al. Endocrinology and Metabolism Clinics of North America, 2015
• Freeman EW et al. Archives of General Psychiatry, 2006
• Thurston RC et al. Obstetrics & Gynecology Clinics of North America, 2011

Let’s start with the reality most women run into at some point in their 40s:
You’re exhausted.
Your sleep is a mess.
Your mood feels… unpredictable at best.
And your body is doing things that make you question if it’s still on your team.
So you start hearing about hormone replacement therapy (HRT).
Then immediately get hit with:

• “Synthetic hormones are dangerous!”
• “Only bioidentical is safe!”
• “Hormones cause cancer!”
• “Hormones will fix everything!”

Cool. Super helpful. Very clear. 🙃
Let’s simplify this—because the truth is a lot less dramatic and a lot more nuanced. Also, before we dive in, let me be very clear that Coach Kayli and I are both taking HRT, but that doesn't mean you have to. We want you to have good information to make informed decisions about your body so you can make the best decisions for you.

First: What Is Hormone Replacement Therapy?Hormone replacement therapy (HRT) is used to restore declining hormone levels, primarily:

• Estrogen
• Progesterone
• Sometimes testosterone

It’s most commonly used during perimenopause and menopause to help manage symptoms and protect long-term health.
According to the North American Menopause Society, HRT is the most effective treatment for menopausal symptoms and can also provide protective health benefits when used appropriately.

Synthetic vs. Bioidentical Hormones: What’s the Difference?This is where things get confusing—and where the internet tends to spiral.
Synthetic HormonesSynthetic hormones are chemically altered and not identical to the hormones your body naturally produces.
Examples include:

• Certain forms of progestins
• Older oral estrogen formulations

Some early studies (like the Women’s Health Initiative) raised concerns about risks with specific synthetic combinations—but those results don’t apply to all modern therapies.  However, it is important to noted that while these are generally safe, they do carry more risk of side effects than bioidentical options.

Bioidentical HormonesBioidentical hormones are structurally identical to the hormones your body makes.
They can be derived from plant sources (like yams or soy) but are processed to match human hormones exactly.
Here’s the important part most people don’t realize:
👉 Many FDA-approved hormone therapies are already bioidentical.
This includes forms of:

• Estradiol (estrogen)
• Micronized progesterone

So “bioidentical” doesn’t automatically mean “custom” or “compounded.”

FDA-Approved vs. Compounded HormonesThis is where things really matter.
FDA-Approved Hormone TherapyThese are regulated, tested, and standardized for:

• Safety
• Dosage consistency
• Effectiveness

Examples include:

• Estradiol patches
• Oral progesterone
• Estrogen gels

The U.S. Food and Drug Administration supports these therapies because they’ve undergone clinical testing.

Compounded HormonesCompounded hormones are custom-mixed by a pharmacy based on a provider’s prescription.
They’re often marketed as:

• “More natural”
• “Personalized”
• “Safer”

But here’s the catch:
They are not FDA-approved, meaning:

• Doses can vary
• Quality isn’t standardized
• Safety data is limited

According to the American College of Obstetricians and Gynecologists, compounded hormone therapy should generally be used only when FDA-approved options are not suitable. Compounded hormones are not necessarily dangerous, but you need to make sure you are trusting a reputable pharmacy. I am currently taking a compounded testosterone cream and I like it. However, testosterone is not FDA approved for women and can be difficult to get an FDA approved version from a normal pharmacy. It is possible, but there are usually questions raised.

Different Types of Hormone Therapy (And Why It Matters)HRT isn’t one-size-fits-all. The delivery method can affect how your body absorbs and responds.
1. Patches (Transdermal Estrogen)

• Applied to the skin
• Steady hormone delivery
• Lower risk of blood clots compared to oral estrogen

2. Pills (Oral Estrogen/Progesterone)

• Convenient
• Processed through the liver
• May slightly increase clotting risk in some women

3. Gels & Creams

• Absorbed through the skin
• Flexible dosing
• Often used for estrogen

4. Vaginal Estrogen (Creams, Rings, Tablets)

• Targets local symptoms (dryness, discomfort)
• Minimal systemic absorption

5. Pellets (Implanted Hormones)

• Inserted under the skin
• Long-lasting
• Often compounded (not FDA-approved)

Signs You Might Benefit from HRTNot every woman needs HRT—but many could benefit from at least exploring it.
Common symptoms include:

• Persistent fatigue
• Hot flashes or night sweats
• Poor sleep or insomnia
• Mood swings, anxiety, or irritability
• Brain fog or memory issues
• Low libido
• Vaginal dryness
• Weight gain, especially around the midsection

If you’re reading this thinking, “Okay wow, that’s… all of them,” you’re not alone.

Benefits of Hormone Replacement TherapyWhen prescribed appropriately, HRT can offer significant benefits:
1. Relief from Menopausal SymptomsHRT is the most effective treatment for hot flashes and night sweats (NAMS, 2022).
2. Improved Bone HealthEstrogen helps maintain bone density and reduces the risk of osteoporosis.
3. Better Sleep and MoodHormone balance can improve sleep quality and reduce mood swings.
4. Cardiovascular Support (When Started Early)Research suggests starting HRT near menopause may support heart health (Hodis & Mack, 2011).
5. Improved Quality of LifeThis one gets overlooked—but feeling like yourself again matters.

Important: HRT Isn’t One-Size-Fits-AllHRT is highly individualized.
Factors that matter include:

• Age
• Health history
• Time since menopause
• Personal risk factors

The North American Menopause Society states that for healthy women under 60 or within 10 years of menopause onset, the benefits of HRT often outweigh the risks.
Translation: timing matters.

Where Fitness and Nutrition Still Come InHRT is powerful—but it’s not magic.
To get the full benefit, it should be paired with:

• Strength training
• Adequate protein intake
• Daily movement
• Stress management
• Sleep support

Because hormones + lifestyle = results.

If You Want Help Navigating ThisIf you’re trying to figure out how to support your body through midlife—whether that includes HRT or not—you don’t have to guess.
You can:
👉 Apply for coaching for a personalized plan around training, nutrition, and lifestyle
👉 Join the Ascend app for structured strength programs designed for women navigating hormonal changes
Because feeling strong, energized, and like yourself again shouldn’t feel this complicated.

Final ThoughtsThe conversation around hormone therapy has been confusing for years.
But here’s the bottom line:

• Not all hormones are the same
• “Bioidentical” doesn’t always mean better
• FDA-approved options are often the safest starting point
• The right approach is individualized

And most importantly:
You deserve to understand your options—and make informed decisions about your body.

Sources

• North American Menopause Society
• American College of Obstetricians and Gynecologists
• U.S. Food and Drug Administration
• Hodis HN, Mack WJ. Menopause, 2011
• Rossouw JE et al. JAMA, 2002